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Biomedical subjects

J Baruch

Publications and source records attributed to J Baruch.

At least 19 recordsLinked to original sources
PubMed2001

Immediate breast reconstruction using a laparoscopically harvested omental flap.

Use of an omental flap to reconstruct the breast after cancer surgery was first reported by Kiricuta in 1963. Since then, the omentum has been widely used in cancer surgery to cover extensive thoracic defects associated with radionecrosis. In contrast, for breast reconstruction or augmentation mammaplasty, rectus abdominis and latissimus dorsi flaps have been used far more often than omental flaps. This article describes a new technique for immediate breast reconstruction using laparoscopically harvested omentum and reports the results obtained in 10 patients. Nine patients underwent immediate breast reconstruction after subcutaneous mastectomy. In the other patient, omentum was used in combination with skin grafting to cover a postmastectomy defect. Follow-up exceeded 16 months in the first patients. The results suggest that breast reconstruction using a laparoscopically harvested omental flap may be extremely dependable in terms of vascular supply (there was one case of partial necrosis, which healed with local management alone). The postoperative course of all patients was uneventful, and the use of laparoscopy reduced the hospital stay to less than 7 days. Donor-site scars were minimal. There was no residual loss of function, and there were no cases of incisional ventral hernia. Cosmetic results were satisfactory, with a soft breast that was both natural in appearance and stable in volume. However, in two patients the amount of omentum was found to be inadequate during the procedure; consequently, an implant was inserted under the omental flap. Breast reconstruction using a laparoscopically harvested omental flap is a new technique that allows autogenous reconstruction without disfigurement of the do-nor site and that results in a soft, natural-looking breast.

Breast Neoplasms↗
PubMed2000

Syncytial giant-cell hepatitis due to autoimmune hepatitis type II (LKM1+) presenting as subfulminant hepatitis.

Giant cell hepatitis (GCH) in adults is a rare event. The diagnosis of GCH is based on findings of syncytial giant hepatocytes. It is commonly associated with either viral infection or autoimmune hepatitis type I. A patient with GCH due to autoimmune hepatitis type II (LKM1+) is described, a combination that has not been previously reported. Corticosteroid therapy was effective in decreasing serum liver enzymes; however, the patient deteriorated rapidly and developed subfulminant hepatic failure. Although an emergency orthotopic liver transplantation was performed, the patient died because of reperfusion injury. Interestingly, only a few giant hepatocytes were noted in the explanted liver. This case stresses the association of GCH with autoimmune disorders, the possible immune mechanism involved in the formation of giant cell hepatocytes, and illustrates the rapidly progressive course and unfavorable prognosis that these patients can develop.

Adult↗
PubMed1998

Advantage of the presence of living dermal fibroblasts within in vitro reconstructed skin for grafting in humans.

Methods for serial cultivation of human keratinocytes can provide large quantities of epidermal cells, which have the potential of restoring the vital barrier function of the epidermis in extensive skin defects such as burns. To investigate the value of combining an epidermis with a dermal component, fibroblasts originated from the superficial dermis were used to seed a collagen lattice as described by E. Bell (dermal equivalent). Beginning in 1981, we grafted 18 patients (burns and giant nevi) using 35 grafts 10 x 10 cm in size. In the course of this work, the original technique was modified and improved as experience was gained. We began by using small skin biopsy samples as a source of keratinocytes cultured on a dermal equivalent before grafting in a one-step procedure, but this gave poor cosmetic results, because of a nonhomogeneous epidermalization. We then chose to cover the graft bed using a two-step procedure. The first step consisted of grafting a dermal equivalent to provide a dermal fibroblast-seeded substrate for subsequent in vivo epidermalization by cultured epidermal sheets. Whatever the epidermalization technique used, a living dermal equivalent applied to the graft bed was found to reduce pain, to provide good hemostasis, and to improve the mechanical and cosmetic properties of the graft. A normal undulating dermal-epidermal junction reappeared by 3 to 4 months after grafting and elastic fibers were detectable 6 to 9 months after grafting. As a result of the biosynthesis of these products, the suppleness (e.g., elasticity) of the grafts was closer to that of normal skin than the cicatricial skin usually obtained with epidermal sheets grafted without the presence of living dermal cells. This rapid improvement of the mechanical properties of the graft could be attributed to the presence of fibroblasts cultured from the dermis and seeded into the collagen matrix.

Adult↗
PubMed1997

Obtaining maximal use of expanded scalp rotation flaps via an experimental model.

The relative inelasticity of scalp skin and the irregular convexity of the cranial vault necessitate careful planning in the design and mobilization of scalp flaps. Rotation flaps adapt particularly well to the curves of the cranial vault. An experimental model has enabled us to study the design and mobilization of expanded scalp rotation flaps and to obtain maximal efficiency from the tissue expansion process. The use of a round tissue expander situated immediately adjacent to a scalp defect is an excellent method for the creation of a rotation flap. To optimize the use of the expanded tissues, the flap should be designed so that its border passes along the periphery of these expanded tissues. In cases in which it is advisable to separate the expander from the defect, such as when the defect is highly contaminated, efficient use of the expanded tissues can still be obtained by placing the expander at the site of a rotation flap backcut. Furthermore, although this study focuses on rotation flaps only, this same model can be used to examine and compare different closure methods using other types of flaps as well.

Child, Preschool↗
PubMed1997

[Skin sensitivity before and after reduction mammaplasty. Report of 44 cases].

The main aim of reductive surgery for breast hypertrophy has often been the aesthetic result without considering on the cutaneous sensitivity. This retrospective analysis studied the subjective and objective sensitivity after mammoplasty reduction 44 patients. The preoperative results showed a reduction of sensitivity directly proportional to the ptosis. After surgery the patients described an improvement of the sensibility, especially in the case of moderate resection. This study shows the good restoration of nerve fibers after chronic stretching due to hypertrophy. Nerve fibres were restored when areolar graft was used.

Adult↗
PubMed1997

[Preservation of the muscle in the use of rectus abdominis free flap in breast reconstruction: from TRAM to DIEP (Deep inferior epigastric perforator) flap. Technical notes and results].

The advantages of TRAM (Transverse Rectus Abdominus Muscle) flap for breast reconstruction is now well recognised. This technique allows a cosmetic reconstruction with a more natural shape than with conventional reconstruction with prosthesis. However the disadvantage is the need of removal of part or all rectus abdominis muscle. If the techniques of free flap are now recognised to be more reliable than pedicle TRAM they have not demonstrate a superiority in term of parietal sequellae. To avoid such problem some teams have progressively developed the DIEP (Deep Inferior Epigastric Peforator Flap). This flap is harvested only on the transmuscular perforators. We are presenting here our expertise which progressively has leed us from free partial TRAM to DIEP. From december 1995 to january 1997 we have practice 18 breast reconstructions with free flap. On 13 DIEP we had only one parietal complication due to incomplete closing of the aponeurosis at the lowest part of the surgical approach. This complication was easily corrected as the muscle was still tonic. On 5 TRAM, clinical examination finds parietal weakness on 3 cases. We believe that this technique is full of promises as it brings autologous tissue with no complication on donor site.

Humans↗
PubMed1996

[Value of reduction mammoplasty in the conservative treatment of breast neoplasms. Apropos of 70 cases].

Breast cancer surgery is on the increase. Until now conservative treatment has been limited to tumors less than 3 cm; it is now extending to surgery on reduced tumors after chemotherapy or radiotherapy. Some cancers still require mastectomy because a carcinologic satisfactory tumorectomy would create a major deformity not compatible with conservative treatment. It is technically possible to perform major tumor resection with good cosmetic results using the reduction mammoplasty technique well known in plastic surgery. Between 1983 and 1991, 70 patients were treated at Henri Mondor Hospital for breast cancer with breast reduction mammoplasty and irradiation. We present the result with an average five years follow-up in terms of the cosmetic results relapses and survival rate. The actuarial local relapse was less than 10%, the survival with local relapse was 86% after 5 years, cosmetic results were good in 81% of cases. The association of reduction mammoplasty and radiotherapy seems to be a good extension of conservative treatment in some large breast tumors.

Actuarial Analysis↗
PubMed1994

bcl-2 expression in normal breast tissue during the menstrual cycle.

bcl-2 is a proto-oncogene discovered through the t(14;18) translocation occurring in most human follicular lymphomas. The function so far attributed to bcl-2 is to counteract the occurrence of apoptosis and to prolong cell survival without affecting the cycling cells. Apoptosis has been described in normal breast tissue epithelial cells, and it peaks at the end of the luteal phase. We have studied bcl-2 expression by an immunohistochemical method in 50 samples of normal breast tissue distributed throughout the menstrual cycle. bcl-2 staining predominated in the lobular epithelial cells. It displayed a striking cyclic variation, with maximal expression at the mid-cycle period and a sharp decrease at the end of the cycle. These results strongly suggest that the regulation of bcl-2 expression in breast tissue is hormone-dependent. This could be of significance in tumorigenesis.

Adolescent↗
PubMed1994

[Mammary silicone granuloma. Apropos of 3 cases].

Since the beginning of the sixties, plastic surgeons now use silicone gel prostheses, in aesthetic or reconstruction surgery, for augmentation mammaplasty. Organic complications occurring after the insertion of these implants are reported in the literature, due to the large number of women now treated. Out of the purely local complications, and the general complications related to silicone biocompatibility, some regional complications are described, such as silicone granuloma. Authors describe three cases of sicilone granuloma they have observed and cured. After a short review of the literature, they underline problems raised by silicone granuloma, such as those related to diagnostic and therapeutic approaches.

Breast Implants↗
PubMed1993

[Pathology of autografts of the nipple in mammaplasty. Apropos of 2 original cases].

Autologous nipple graft is a classical technique in nipple reconstruction. The authors present two cases of deferred development of specific lesions in the grafted nipple, including one historical case of Paget's disease. After reviewing the current state of knowledge concerning Paget's disease of the nipple and in the light of these two cases, the authors discuss the histogenesis of this disease and the pathology of the grafted nipple in reconstructive surgery.

Adult↗
PubMed1993

[Basal cell carcinoma of the nose].

UNLABELLED: The purpose of this study of 81 patients with basal cell carcinoma (BCC) of the nose was to present the oncological and cosmetic results of surgical treatment and compare these results with those of other possible treatments. MATERIAL AND METHOD: We report a series of 81 cases of histologically proven BCC of the nose located chiefly on the alae nasi and on the lower end of this organ; 42 p. 100 of the tumors had previously been treated and had recurred. The patients' mean age was 63 years, and the shortest follow-up was 3 years. Excision of the tumor under simple or reinforced local anaesthesia was complete in 88 p. 100 of the cases, incomplete or borderline in 12 p. 100 and systematically repeated. Extemporaneous histological examination was performed in 18 p. 100 of the cases. The operative lesion was repaired with a graft or a flap. There was no postsurgical treatment. RESULTS: The recurrence rate was 4 p. 100 with a minimum follow-up of 3 years. The cosmetic result was good in 78 p. 100 of the patients. DISCUSSION: Numerous treatments have been used against BCC of the nose, the results, advantages and disadvantages of each of these treatments are given below: 1. Cryosurgery. The problem with this method is that it is relatively difficult to perform and requires reliable operators. The cure rate is similar to that of other treatments. 2. Chemotherapy is not frequently used. 3. Electrocoagulation. Contrary to the conventional excision, this method precludes all histological controls, and the common idea of good oncological results is now being revised. 4. Radiotherapy. The recurrence rate varies from 7 to 11.8 p. 100 with fair cosmetic results. It requires numerous sessions, cannot be repeated in case of recurrence and complicates the surgical treatment. In addition, there is a long-term risk of radiodystrophy. 5. Curietherapy by local implantation of 192Iridium has a recurrence rate of 2.5 to 7 p. 100. This treatment requires hospitalization and is costly. It is indicated in cases of complex surgery, difficult conventional radiotherapy and above all, sclerodermatous BCC. 6. Surgery has a recurrence rate which varies from 3.7 to 12.6 p. 100. Recurrences are due to insufficient excision, and this underlines the value of histological control which can be done only at surgery. It is a rapid and ambulatory treatment, usually performed under local anaesthesia. The cosmetic result is good (85 to 90 p. 100) and the patients must be made aware of this preoperatively with some degree of reliability, depending on age, location, size of BCC and on the surgical technique utilized. CONCLUSION: Surgical treatment of nasal BCC is safe, effective and rapid, with good oncological and cosmetic results, and it has many advantages over the other treatments.

Adult↗
PubMed1992

[Effect of inadequate filling of deflation of inflatable breast prostheses. Statistical study of 535 inflatable prostheses].

This study was based on a series of 535 inflatable prostheses used for breast reconstruction or augmentation with a mean follow-up of 5.15 years. The authors specifically analysed the statistical correlation between underinflation and deflation due to late rupture. They demonstrated a statistically significant difference between the initial filling of the prostheses which subsequently deflated and the initial filling of all prostheses of the series. The mean filling of prostheses which subsequently deflated was 89% while the mean filling of all prosthesis in the series was 100%. The various pathologies are analysed according to the cosmetic or reconstructive indications. The two series, cosmetic and reconstructive, were homogeneous in terms of filling volume and deflation; the only difference concerned the age distribution. Patients undergoing breast reconstruction with a prosthesis were older than patients undergoing augmentation surgery for small breasts. The authors discuss the advantages and disadvantages of this type of prosthesis.

Adolescent↗
PubMed1992

[Plastic surgery and conservative treatment of breast cancer. Indications and results].

After conservative treatment for breast cancer, 75% of patients have good cosmetic results, but 20 to 25% of patients have a fair or a bad result. The tumor itself is responsible for some of these bad results (tumor volume, location in the inferior quadrants of the breast) but more often, failures are related to surgery and/or radiotherapy. Some patients will then ask for reconstructive surgery. It should always be preceded by a careful examination of the breast, both with an oncologic and a reconstructive approach. The techniques used are numerous, ranging from simple reexcision of the lumpectomy scar to mastectomy with immediate TRAM flap reconstruction. We believe that plastic surgery techniques should be used as soon as the initial lumpectomy, as they help to fill in the defect. In the case of a tumor located in the inferior quadrants, bad cosmetic results are twice as frequent as in the upper quadrants: we treated 16 of these patients with immediate bilateral breast reduction, reshaping the breast at the same time as the lumpectomy, and achieving symmetry of the contralateral breast. This technique did not interfere with radiotherapy or chemotherapy. When radiotherapy followed surgery, cosmetic results were good. Local and distant recurrences were not modified by the adjunction of a breast reduction to the lumpectomy. In 49 cases, we also proposed a bilateral breast reduction for larger tumors (T > 3 cm, bifocal cancer). 4-year local recurrence rate was less than 10%: this technique could help to extend the indications for conservative treatment for breast cancer. More cases and longer follow-up are necessary.

Breast Neoplasms↗
PubMed1992

[Surgical injury of the temporo-frontal branch of the facial nerve. Anatomical study and clinical consequences].

The frequency of frontal paralysis due to surgical trauma of the temporo-frontal nerve seems to be increasing due to the growing number of operations in the temporo-frontal area and the complexity of surgical techniques. A series of 20 anatomical dissections demonstrates the course of the temporo-frontal nerve. Frontal myomectomy of the healthy side to allow facial equilibration seems to us to be the best technique of reconstructive surgery for definitive frontal paralysis.

Aged↗
PubMed1991

Evaluation of adjuvant psychological therapy for clinically referred cancer patients.

Adjuvant psychological therapy (APT) is a newly developed cognitive behavioural treatment which has been designed specifically to improve the quality of life of cancer patients by alleviating emotional distress and inducing a fighting spirit. We report a phase I/II study which evaluates APT in routine clinical practice. A consecutive series of 44 outpatients with various cancers referred for psychiatric consultation and receiving APT at the Royal Marsden Hospital was studied. Standardised self-report questionnaires were used to measure anxiety, depression and four principal categories of mental adjustment to cancer, namely, fighting spirit, helplessness, anxious preoccupation and fatalism. Statistical comparisons between pre-therapy scores and scores after an average of five APT sessions revealed significant improvement in anxiety, depression, fighting spirit, anxious preoccupation and helplessness. Fatalism scores showed the same trend, but the changes were smaller. Patients with advanced disease showed as much improvement as those with local or locoregional disease. Present results indicate improvement in both psychiatric symptoms and mental adjustment to cancer associated with APT. Whether this association is causal remains to be determined by randomised controlled trials. Such a trial is in progress.

Adolescent↗
PubMed1990

[Can tumors of the breast larger than 3 centimeters be treated conservatively?].

Unlike small breast cancers, which are now treated conservatively by primary tumorectomy, the most important lesions (T2 and T3) as usually treated tumorectomy, the most important lesions (T2 and T3) as usually treated by mastectomy. However, in patients with these large lesions attempts may be made at conserving the breast with reliable oncological safety and good cosmetic results. Depending on clinical presentation, one or the other of two therapeutic approaches may be considered. The most common treatment is preoperative radiotherapy of 45 Gy which, in more than 50 p. 100 of the cases results in a tumoral regression that is sufficient for secondary tumorectomy to be performed. In some patients, the first-line treatment consists of wide tumoral excision as part of a reductive mammaplasty, followed by radiation.

Breast Neoplasms↗